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The peculiarities of surgical treatment of atrial septal defect for adults


Author: Corcea Vasile
Degree:doctor of medicine
Speciality: 14.00.44 - Cardiovascular Surgery
Year:2008
Scientific adviser: Anatol Ciubotaru
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:

Status

The thesis was presented on the 5 September, 2008
Approved by NCAA on the 23 October, 2008

Abstract

Adobe PDF document0.41 Mb / in romanian

Thesis

CZU 616.125.6-089

Adobe PDF document 4.13 Mb / in romanian
142 pages


Keywords

atrial septal defect, diagnoses and surgical treatment, risk factors, complications, health quality

Summary

In this research paper were exposed the results of surgical treatment of 213 sick people, that were surged in the Centre of Heart Surgery in the period of 1988 till 2006.

The aim of this study was to evaluate the factors uncertainty in the surgical treatment of atrial septal defect (ASD) at adults and evaluation of an algorithm of diagnosis and optimized treatment. From the total number of surged patients; 130 (19,9%) were between 19-59 years old. They constitute the base of this research (33,05±0,8) named as the 1st group. The 2nd group which comprises 83 surged children and adolescents from 2 to 18 years old (in medium 10,75±0,5). Atrial septal defects were localized in the central septal portion in 55,4% of cases. Surgical application was though the median sternotomy at 208 (97,7%) patients and at 5 (2,3%) the way of appliance was the right toracotomy .

Associated cardiac pathology in the 1st group of patients were present in 44,5% and in the 2nd group in 73,5%. The most associated pathology at adult patients was the insufficiency of tricuspid valve, diagnosed at 20 (15,4%) patients. Extracardiac associated pathologies were detected in the 1st group of patients in 20 (15,4%) cases, but in the 2nd group only in 1 (1,25%) patient. This clinical state was studied at patients with ASD, which ascertained a slow frequency of accuses in the 2nd group of patients with growing indicators that reached to 100% (the group of patients older then 40 years).

Through involvement of the post precocious surgical period, the unset rhythm dominated at adults and consisted 11,7%. Summing these complications at children and adults - 3,6% are received. Appreciation of patients life with ASD, that were subdued to the surgery, a good result was established in 89 (47,9%) cases, a satisfactory result in 80 (43,0% ) cases and a non satisfactory result in 8 (7,4%) cases. The most favourable period of closing a ASD is till the age of 18 years, when the pulmonary hypertension is developed slowly and did not cause the appearance of pulmonary resistance, myocardium hypertrophy and dilatation of cord cavities.